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Surgical neoangiogenesis in patients with Moyamoya disease: the balance between direct and indirect revascularizationтезисы доклада
- Авторы: Shulgina A., Lukshin V., Usachev D., Kobiakov N.
- Сборник: Abstract Book | 18th World Congress of Neurosurgery | Cape Town, South Africa
- Тезисы
- Год издания: 2023
- Место издания: Cape Town, South Africa
- Первая страница: 599
- Последняя страница: 599
- Номер статьи: 694
- Аннотация: Objectives: The effect of surgical revascularization in patients with Moyamoya disease is based on postoperativecollateral formation, however, the balance between direct and indirect revascularization is still to be determined.Background: To determine the efficiency factors of neoangiogenesis of direct and indirect components ofrevascularization, indications and tactics for their combined use.Methods: We analyzed 80 patients with Moyamoya disease who underwent 134 surgical interventions. The maingroup consisted of patients after combined revascularization (79 operations), 2 control groups - after indirect (19) anddirect (36) operations. Post- and intraoperative MRI images were studied, the function of each of the components ofrevascularization was evaluated based on angiographic and perfusion modes and their contribution to the overallresult of revascularization, on the basis of which various degrees of their effectiveness were distinguished.Results: Statistical analysis showed that the efficiency factors of the direct components of revascularization are thelarger diameter o f the acceptor (p=0.028) and donor (p<0.0001) arteries and the imposition of double bypasses(p=0.009). The efficiency factors of indirect synangiosis are the younger age of patients (p=0.009), the ivy sign on MRI(p=0.005), dilatation of the M4 branches of the middle cerebral artery (p=0.026), the presence of transdural (p=0.004)and leptomeningeal (p=0.001) collaterals and the use of more indirect components (p=0.027). The best angiographic(p=0.023) and perfusion (p<0.0001) results of revascularization are achieved with the combined influence of directand indirect components. The use of intraoperative control, including the ioMR perfusion study, makes it possible toidentify areas of residual hypoperfusion and determine indications for additional revascularization.Conclusions: Rational use of a combination of direct and indirect revascularization methods, taking into account thefactors of their effectiveness and dynamic intraoperative perfusion data, allows achieving the targeted restoration ofblood flow during surgical revascularization in patients with Moyamoya disease
- Добавил в систему: Шульгина Анна Алексеевна